Lesion Severity and Hypercholesterolemia Determine Long-Term Prognosis of Vasospastic Angina Treated With Calcium Channel Antagonists

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• Although patients with medically treated vasospastic angina have a good outcome, few data exist regarding the role of underlying lesion severity associated with or without hyperlipidemia in the prognosis. Therefore, the aim of the present study was to assess the relationship between the long-term outcome of vasospastic angina and the factors influencing its prognosis. A total of 256 patients (219 men, 37 women; mean age, 54.1±9.2) who had coronary spasm with or without underlying lesions and were being treated with calcium channel antagonists were enrolled and followed for 13.6±3.7 years. Cardiac events consisted of cardiac death and ischemic events, which included acute myocardial infarction and unstable angina. Cox analysis selected coronary artery stenosis (CAS, ≥50%) and risk factors such as age, hypertension, diabetes mellitus, low-density lipoprotein-cholesterol (LDL-C), sex and smoking. There were 19 cases of cardiac death (7.4%) and 58 of ischemic events (22.7%) during the follow-up period. The presence of significant GAS was an independent predictor of event-free survival (hazard ratio (HR) =2.84, 95% confidence interval (CI) =1.79-4.52, p<0.0001). In 193 patients without significant GAS, there were 10 cases of cardiac death (5.2%, p<0.05) and 34 of ischemic events (17.6%, p<0.01). In that group, high LDL-C was the independent predictor of event-free survival (HR=3.89, 95% CI= 1.20-12.6, p=0.02). Kaplan-Meier survival analysis revealed significantly lower event-free survival in patients with than in those without lesions (p<0.0001 by log-rank test). These results demonstrate that the most important factor for long-term prognosis of vasospastic angina treated with calcium channel antagonists is significant GAS. High LDL-C, which might alter the underlying coronary endothelial function and/or accelerate atherosclerotic lesions, could also contribute to the occurrence of cardiac events, particularly in patients without significant GAS. (Circ J 2003; 67: 1029-1035)

• 社団法人日本循環器学会の論文
• 2003-11-20

著者

• KITAKAZE Masafumi

  Division of Cardiology, National Cardiovascular Center

• GOTO Yoichi

  Division of Cardiology, National Cardiovascular Center

• NONOGI Hiroshi

  Division of Cardiology, National Cardiovascular Center

• TOMOIKE Hitonobu

  Division of Preventive Cardiology, National Cardiovascular Center

• MIYAZAKI Shunichi

  Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, Fujishiroda

• Hiro Takafumi

  Departments Of Internal Medicine And Cardiology Osaka City University Graduate School Of Medicine

• Nonogi Hiroshi

  Division Of Cardiology And Emergency Medicine National Cardiovascular Center

• Kitakaze Masafumi

  Division Of Cardiology National Cardiovascular Center

• NAGAYA Noritoshi

  Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center

• Sumiyoshi Tetsuya

  Division of Cardiology, Sakakibara Heart Institute

• Yamagishi Masakazu

  Division Of Cardiology First Department Of Medicine Osaka University School Of Medicine

• Haze Kazuo

  Division Of Cardiology Department Of Medicine National Cardiovascular Center

• Fukami Kenichi

  Division Of Cardiology Iwate Medical College

• Ito Kenichi

  Division of Cardiology, National Cardiovascular Center

• Takaki Hiroshi

  National Cardiovasucular Center

• Masuda Yoshikazu

  Japanese Brugada Multicenter Registry By The Minister Of Health Labour And Welfare National Cardiova

• Fukami Kenichi

  Division Of Cardiology Department Of Internal Medicine Memorial Heart Center Iwate Medical Universit

• Shiga Tsuyoshi

  Department Of Cardiology Tokyo Women's Medical University

• Shiga Tsuyoshi

  Department Of Cardiology The Heart Institute Of Japan Tokyo Women's Medical University

• Tsutsui Hiroshi

  Division of Cardiovascular Medicine, Shinshu University School of Medicine

• Nagaya Noritoshi

  Department Of Regenerative Medicine And Tissue Engineering National Cardiovascular Center Research I

• Fukami Kenichi

  Iwate Medical University

• Miyazaki Shunichi

  Division Of Cardiology Department Of Internal Kinki University School Of Medicine

• Goto Yoichi

  Division Of Cardiology Department Of Medicine National Cardiovascular Center

• Tsutsui Hiroshi

  Division Of Cardiology Department Of Medicine National Cardiovascular Center

• Takenaka Hiroaki

  First Department Of Surgery Yamaguchi University School Of Medicine

• Fakami Kenichi

  Cardiac Division Department Of Internal Medicine National Cardiovascular Center

• Nagaya Noritoshi

  Department Of Regenerative Medicine And Tissue Engineering National Cardiovascular Center

• Tomoike Hitonobu

  Division Of Cardiovascular Medicine National Cardiovascular Center

• Takaki Hiroshi

  Division Of Cardiology National Cardiovascular Center

• Takaki Hiorshi

  Department Of Cardiovascular Dynamics National Cardiovascular Center Research Institute

• Nagaya Noritoshi

  Department Of Regenerative Medicine And Tissue Engineering National Cardiovascular Center Research I

• Nagaya Noritoshi

  Regenerative Medicine And Tissue Engineering National Cardiovascular Center And Research Institute

• Nagaya Noritoshi

  Department Of Regenerative Medicine And Tissue Engineering National Cardiovascular Center Research I

• Tsutsui Hiroshi

  Division Of Cardiovascular Medicine National Cardio Vascular Center

• Nonogi Hiroshi

  Division Of Cardiac Care Unit Department Of Cardiovascular Medicine National Cerebral And Cardiovasc

• Nagaya Noritoshi

  Cardiovasclular Dynamics Dept National Cardiovascular Center

• TOMOIKE Hitonobu

  Sakakibara Heart Institute

• Ito Kenichi

  Division Of Cardiovascular Medicine National Cardio Vascular Center

• Yamagishi Masakazu

  Division Of Cardiology Department Of Internal Medicine Kanazawa University Graduate School Of Medici

• Nagaya Noritoshi

  Department Of Regenerative Medicine And Tissue Engineering National Cardiovascular Center Research I

• Tomoike Hitonobu

  Division Of Cardiovascular Medicine

• Sumiyoshi Tetsuya

  Division Of Cardiology Sakakibara Heart Institute

• TOMOIKE Hitonobu

  Division of Cardiology, Okayama University

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